Dwight Pargee March 22, 2009 My saga So I’m sitting here with an iv in my arm, getting my daily dose of antibiotics and reflecting back over the last two years, thought I’d share my story. The good news is I won’t be buying any new shoes for the next couple of months, actually that’s not so good news because I love buying shoes…but I digress. Back in 1997 I was 33 and playing in a rugby game on sticky muddy field. I had the ball in hand, made a cut, my foot stuck in the mud and bang!…I dislocated my hip and fell like someone shot me… the hip was reduced back into place and I was diagnosed with a torn labrum…I was treated with PT, strength training, pilates and feldenkrais and got back most of my function within a year, even able to play a bit of rugby, but my gait was definitely permanently affected. Fast forward 10 years and the hip is now bone on bone and end stage osteoarthritis, I’m the perfect candidate for a resurfacing, my insurance company doesn’t agree and I fight them for two years until they finally approve resurfacing with Dr. Boyd and a Cormet implant in Oct. 2007. I recover well and a year and a half later, I’m able to mountain bike 20-30 miles at a time without pain, still got kind of a limp on long mountain hikes though. then last fall I start getting more discomfort and groin pain, and on Christmas eve my car gets stuck in the snow, I push and pull and dig for an hour and half in blizzard conditions, when I get it free, I can’t bear weight through my leg, severe pain. I go to emergency room, get an x-ray, no fracture or dislocation, and am diagnosed with severe muscle strains in the adductors and piriformis. my surgeon prescribes antiinflammatories, PT as tolerated and crutches for 6-8 weeks..crutchin it for two months, I make slow progress, pain is somewhat reduced and weight bearing ability seems to improve. About three weeks ago, I felt severe pain returning while grocery shopping. quickly, I go to ER in the middle of the night, x-ray again shows nothing, the CT-scan shows fluid/inflammation build up around the joint, emergency surgery is scheduled, they open me up and find a low-level staph infection and clean out a massive of loose body debris called rice bodies* (see appendix). I now start daily iv antibiotic therapy for six weeks to kill the staph infection, we surmise the staph entered my system through possibly a light bloody nose that I had got in response to cold dry winter air a couple of days before, no other cuts or signs of infection. my surgeon says that they have been culturing everyone coming in for hip and knee implants and they are finding staph in 1 out of 50 people in their noses. They install a port into my arm runs directly into my vena cava to deliver the antibiotic. Two weeks ago Thursday I go into my orthopedic surgeon, expecting to get my staples removed and looking forward to being able to get into the pool and start some rehab. Not so fast. had a new set of x-rays taken and then when I was in the room with the surgeon he pulled up my x-rays on his computer, three sets, one from December, one from two weeks and one from that morning…..he pointed out what was askew, I said, “I’m fooked!”….and he said,” well, yes basically you are fooked”…. I didn’t need my degree in biomechanics to see that my acetabular cup had shifted about 5 degrees, north by northwest…..he surmised the infection had gotten in behind the implant and loosened it, and it was slipping periodically, causing my massive pain with certain movements. Last Tuesday I had another surgery to remove my MoM parts and put in a an antibiotic impregnated cement spacer. I leave that in for six weeks, non-weight bearing on crutches and continue with my daily IV antibiotic therapy. After six weeks, they go back in and give me a full hip replacement, this time probably a ceramic on poly total hip. The good news is that they think that with this protocol I have a 80-90% percent of full recovery, and have been very successful in treating my kind of staph infection with this protocol, it just takes awhile and is a two-step process. Already, I’m much more comfortable with the pain level greatly decreased and even though I’m non-weight-bearing, I will be able to return to my work as an exercise physiologist and rehab specialist part time in a week or two. I’m looking forward again to my next surgery and then my full recovery after that. For now, I’m a bit tired. Best, Dwight LCormet Dr. Boyd Oct. 2007 total hip revision in progress * appendix my surgeon just forwarded these pubmed links, he thinks the rice bodies were formed by a type IV immune response to the MoM metal alloys.
Type IV Immune Response: Cell Mediated Reactions Delayed hypersensitivity (cell-mediated) tissue damage results from the interaction between sensitized T cells and specific antigen, which leads to the release of soluble effector substances called lymphokines, direct cytotoxicity, or both. Type IV reactions are involved in many autoimmune and infectious diseases, but may also involve contact dermatitis (poison ivy). These reactions are mediated by T cells, monocytes, and macrophages. Necrotic granulomatous pseudotumours in bilateral resurfacing hip arthoplasties: evidence for a type IV immune response. Pandit H, Vlychou M, Whitwell D, Crook D, Luqmani R, Ostlere S, Murray DW, Athanasou NA. Virchows Arch. 2008 Nov;453(5):529-34. Epub 2008 Sep 4.
Article Website Page Pseudotumours associated with metal-on-metal hip resurfacings. Pandit H, Glyn-Jones S, McLardy-Smith P, Gundle R, Whitwell D, Gibbons CL, Ostlere S, Athanasou N, Gill HS, Murray DW. J Bone Joint Surg Br. 2008 Jul;90(7):847-51. PMID: 18591590 [PubMed – indexed for MEDLINE]
1: Acta Orthop. 2007 Apr;78(2):211-20. Links Neo-capsule tissue reactions in metal-on-metal hip arthroplasty. Witzleb WC, Hanisch U, Kolar N, Krummenauer F, Guenther KP. http://www.ncbi.nlm.nih.gov/sites/entrez> 1: J Arthroplasty. 2008 Oct;23(7):1080-5. Epub 2008 Mar 14. Links Metal sensitivity as a cause of groin pain in metal-on-metal hip resurfacing. Campbell P, Shimmin A, Walter L, Solomon M.
Frequency of occurrence, mode of development, andsignificance of rice bodies in rheumatoid joints